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Background: Diaphragmatic injuries are infrequent but severe injuries, associated with high morbidity and mortality., Methods: The hospital records of 58 patients with traumatic rupture of diaphragm which was diagnosed during surgery in emergency department during last five years were re-evaluated, in order to identify the factors on mortality., Results: The mean age of patients was 33 years. The most common cause of diaphragmatic rupture was penetrating injury (52%). The overall mortality rate was 21%. Preoperative diagnoses were accurately made in only twelve (20%) patients and remaining 46 patients were diagnosed during surgery. Rupture was located on the left side in 42 patients. Intrathoracic herniation was seen in eleven cases. Presence of herniation has no effect on mortality (p=0.155). All cases with mortal course were blunt trauma and the most common cause of death was haemorrhagic shock. Associated injuries were present in 88% of the patients; 92% of the mortal cases had an associated injury., Conclusion: The diagnosis of diaphragmatic injury is important due to increased morbidity and mortality in traumatic victims. Blunt trauma, increased grade of injury, presence of shock, blood transfusions over three units and splenic injury are factors influencing mortality in traumatic ruptures of diaphragm.

Background: The difficulties in diagnosing traumatic diaphragmatic rupture (TDR) at the first admission are the most common causes of morbidity and mortality. The purpose of this study was to review our experience with the management of TDR in order to identify the factors contributing to diagnostic delay and associated morbidity and mortality., Methods: Fourteen patients with TDR were treated in our hospital between January 2000 and June 2005. They have been investigated retrospectively., Results: The study identified 9 men (64 %) and 5 women (36 %), with ages ranging from 19 to 65 years (mean 35.3 years). Rupture of the diaphragm was left-sided in 10 (71 %) and right-sided in 4 (29 %) of the patients. Blunt trauma accounted for the injuries of 11 patients (79 %). Early diagnosis was obtained in 9 patients (64 %). The diagnosis was established preoperatively in 8 patients (57 %), and intraoperatively in 4 (29 %). The diagnosis was missed in 2 (14 %) patients in the first operation. Multiple associated injuries were observed in 12 patients (85 %). Postoperative complications were encountered in five patients (35 %), and the overall mortality was 7 %., Conclusions: Diaphragmatic rupture should be suspected in all blunt or penetrating traumas of the thorax and abdomen, and the presence of such an injury should be excluded before terminating the exploratory procedure.

Objectives: We retrospectively evaluated the functional results of patients who were treated surgically for post-traumatic isolated subscapularis tendon ruptures., Methods: The study included six patients (5 males, 1 female; mean age 63.3 years; range 53 to 70 years) who were operated on for isolated post-traumatic subscapularis ruptures. The mean interval between the development of symptoms due to trauma and operation was 4.3 months (range 1 to 9 months). Mechanism of injury, complaints, clinical findings, imaging methods, arthroscopic and surgical findings, repair techniques, and postoperative follow-up data were assessed. Evaluations were based on physical assessment, radiographic examination, and the UCLA (University of California at Los Angeles) score. The mean follow-up was 29.6 months (range 13 to 53 months)., Results: The mean UCLA score was 11.3 (range 9 to 14) preoperatively. It increased to 25.8 (range 12 to 31) postoperatively (p<0.05). The results were good in four patients, fair in one patient, and poor in one patient. Magnetic resonance images obtained in five patients at the final follow-up showed total rupture in the patient with poor outcome, partial rupture in the patient with fair outcome, and maintenance of tendon integrity in the remaining patients., Conclusion: A careful clinical examination may enable the diagnosis of subscapularis tendon ruptures. Magnetic resonance imaging may provide additional information. In most patients, the repair of the tendon is possible by proper protection of the axillary nerve and appropriate mobilization.

Both main bronchial disruption and chylothorax are uncommon injuries associated with blunt thoracic trauma. We report the case of a patient who presented late after traumatic rupture of the right main bronchus who also had a traumatic chylothorax.